This document provides an overview of dysphagia (difficulty swallowing) including the anatomy, physiology of swallowing, types, causes, and approach to dysphagia. It discusses the physiology of deglutition controlled by the parasympathetic and sympathetic nervous systems. It describes the different phases of swallowing. There are two main types of dysphagia - oropharyngeal and esophageal. Oropharyngeal dysphagia can be caused by structural issues, problems with propulsion, or neurogenic/myogenic issues. Esophageal dysphagia can be caused by extra luminal issues, problems in the esophageal wall, or issues in the esophageal lumen. The document outlines the approach
What is a dysphagia? What are the latest trends to deal with the case who has presented to you? This "Seminar Presentation" list some of the latest American College of Surgery guidelines, regarding the management of a case of dysphagia
What is a dysphagia? What are the latest trends to deal with the case who has presented to you? This "Seminar Presentation" list some of the latest American College of Surgery guidelines, regarding the management of a case of dysphagia
Evaluation of a patient with dysphagia: Difficulty in Swallowing.
Esophageal and Pre-esophageal causes.
-Abhinav Kumar, Kasturba Medical College, Mangalore
Prepared from book: "Diseases of Ear, Nose and Throat
Textbook by P. L. Dhingra" 6th Edition
https://books.google.co.in/books?id=0ByMBgAAQBAJ&lpg=PP1&pg=PA347#v=onepage&q&f=false
Evaluation of a patient with dysphagia: Difficulty in Swallowing.
Esophageal and Pre-esophageal causes.
-Abhinav Kumar, Kasturba Medical College, Mangalore
Prepared from book: "Diseases of Ear, Nose and Throat
Textbook by P. L. Dhingra" 6th Edition
https://books.google.co.in/books?id=0ByMBgAAQBAJ&lpg=PP1&pg=PA347#v=onepage&q&f=false
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Surgical options for Obstructive sleep apnoea syndromeGirish S
OBSTRUCTIVE SLEEP APNEA SYNDROME- REVIEW AND VARIOUS SURGICAL OPTIONS IN DETAIL.. based on Cummings & Scott new edition.. MS OTORHINOLARYNGOLOGY...
complete and detailed review of each operations like uvulopalatoplasty,epiglottoplasty, pillar implantation, tongue base reduction, laser and coblation techniques.. .
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
11. What isdysphagia?
• DYSPHAGIA in Greek means Difficulty to eat.
• In common practice, dysphagia is a term encompassing the
sensations (short of pain) associated with abnormal bolus
transit from mouth to stomach as well as other signs or
symptoms accompanying abnormal transit.
12. TYPES
• Basedon location : - Oropharyngeal
- Esophageal - Extraluminal
- In the wall ofesophagus
- in the lumen
• Based on circumstances : - Structural
- Propulsive
• Basedon onset : -Acute
- Chronic
• Basedon progression : - Progressive
- Intermittent
13.
14. • Oropharyngeal dysphagia
• typically complain of food
lodging or sticking in the back
of the throat or cervical
esophageal region
• Hesitation with swallowing,
frequent and repeated
swallowing attempts, and
throat clearing may accompany
dysphagia
• Esophageal dysphagia
• reflects disorders of the
esophageal body and
esophagogastric junction as well
as anatomical areas abutting
these regions, such as the
gastric cardia and mediastinum
• most telling feature differentiating
esophageal from oropharyngeal
dysphagia is the sensing of
abnormal bolus transit at a
retrosternal site
15. • Oropharyngeal dysphagia
• Related symptoms include
rough or dysphonic voice after
eating and hoarseness may
reflect the underlying
neuromuscular disorder.
• onset of dysphagia within 1 s of
swallowing, inability to swallow
any liquids or solids once a food
bolus is lodged, and
expectoration rather than
regurgitation of the bolus.
• Esophageal dysphagia
• In contrast to oropharyngeal
dysphagia, esophageal
dysphagia is not immediate.
• patients with esophageal
dysphagia regurgitate foamy,
bland secretions or ingested
liquids that have been retained
above the impacted food.
44. Evaluation of apatient with dysphagia
• Proper history
• Hematocrit
• Chestxray often shows mediastinal masslesion/foreign body
• Oesophagoscopy:-
once lesion is detected, it is treated accordingly. Biopsyfrom
lesion, endotheraphy if needed carried out (like foreign body removal,
stricture dilatation, sclerotheraphy)
45. DIAGNOSTICPROCEDURES
• Barium swallow:-It may show irregular filling defect orextrinsic
compression
CONTRASTSTUDYOFOESOPHAGUS
1.Barium swallow using barium suphate
2.Using water soluble contrast like GASTROGRAFIN
46. •Indications:-
1.Barium swallow
-Dysphagia due to motility disorder like achalasia cardia,diffuse
esophageal spasm
-Dysphagia due to mechanical causeslike carcinoma, benign strictures
and neoplasms, external compression
-Pharyngeal pouch and other diverticula.
-Gastro esophageal reflux disease
47. • Important findings in bariumswallow:-
Achalasia cardia-BIRD BEAKappearance asthe esophagus is
dilated above an apparent narrowing at thecardia.
In long standing cases-SIGMOIDOESOPHAGUS
51. • Pharyngeal pouch-demonstration of the pouch
• External compression-indentation of barium column by superioror
posterior mediastinal mass,enlarged left atria asin mitralstenosis
53. • CTscan:- It is very useful to identify the anatomical lesion ofthe
cause(nodes/tumor/aorta/cardiac cause/congenital).
Extent,spread,nodal status,size and operabilityof tumor also cn be
assessed.
54. • Oesophageal manometry:
-It is used to measure the function of the lower oesophageal
sphincter(the valve prevents the reflux of gastric acid intooesophagus)
and the muscle of theoesophagus.
-This test will tell your doctor if the oesophagus is able to move
food to your stomachnormally.
-It is useful to rule outachalasia cardia/GERD
55.
56. • 24 hours monitoring:-
-It is ideal and most accurate forGERD
Procedure:-
-small pHprobe(transnasal catheter) is passedinto oesophagus 5cm
proximal to lower oesophagealsphincter
-probe is connected to digital recorder worn by the patient for 24 hrs
-record is analysed using a computer
If pH<4more than 4%of total 24 hrsperiod
Pathological reflux
57.
58. -It is often assessedby scoringsystem
-Radio-telemetry pHprobes aeused now without any nasal tube
-It is placed and passedon the oesophageal wall usingendoscope
59. • Endosonography:-
-Endoscopic sonography
-can assesssite ,layers of the oesophagus,nodes,spread etc
-Different layers are seenasalternating hyperechoic bands and
hypoechoic bands.
Endoscopyis combined with ultrasound to obtain images ofthe
internal organs(insertion of probe into holloworgan)
-It is performed with the patientsedated
-The endoscope is passedthrough the mouth and advance through the
oesophagus
60. -useful method of finding and assessinginvolvement
or pathology of different layers of esophagus especially in carcinoma
• -It shows all layers clearly and distinctly and soinvasion canbe
better made Staining using is labelled iodine
• Normal mucosal cells contain glycogen which takes up iodine andso
stains brown
• Carcinoma cells will not take up iodine and somucosa appearspale
62. • Oesophagoscopy
Indications:-
Diagnostic
1.T
oidentify the lesion and to take biopsy in carcinoma
oesophagus 2.for diagnosing other oesophageal conditions
Therapeutic:-
1.T
oremove foreign body
2.T
odilate stricture
3.T
oplace endostents for inoperable carcinoma oesophagus
4.T
oinject sclerosants for varices
63. • TYPES:-
• Rigid osophagascope(Negus type)
-It is done underanesthesia
-Head is extended and head end of the table is tiltedupwards,
scope is passedbehind the epiglottis and cricoid through the
cricopharyngeal opening.
-this is the most difficult part inoesophagoscopy
-after that negotiating through the oesophagus iseasier
-The lesion is identified and biopsy is taken if required.
COMPLICATION:-perforation (at the level of cricopharyngeus ismost
common) and bleeding
64.
65. • Fibreoptic flexible oesophagoscopy
-It canbe under localanesthesia
-Reflux and hiatus are well identified
-Stomach also canbe visualized
-easyto passand perforation isunlikely
Drawbacks:
-Tissue taken for biopsy issmaller
-Removal of foreign body is alsodifficult
66.
67. • Third spaceendoscopy:-
-It is anewer method wherein submucosal and intramural spewhich
is called as3rd space(1stbeing luminal spaceand 2nd being peritoneal
space)
68. TREATMENT
Depend on cause–modified heller’s myotomy:-
it is a surgical procedure in which muscles of the cardia(lower
oesophageal sphincter are cut, allowing food and liquids to pass the
stomach.
used to treat achalasiacardia
69. • Procedure
Thepatient is put under anesthesia
5or6 small incision are made in the abdominal wall andlaparoscopic
instruments are inserted
The myotomy is lengthwise cut along the oesophagus, starting above
the LES and extending down onto the stomach alittle way
the oesophagus is made of several layers and the myotomy only cuts
through the outside muscle layers which are squeezing it shut, leaving
the inner mucosal layerintact.
Small risk of perforation is there duringmyotomy
70. • OESOPHAGEALRESECTION:-
it is the surgical removal of oesophagus, nearby lymphnodes and
sometimes aportion of the stomach
TYPES:-
ESOPHAGECTOMY:-it is the surgical removal of oesophagusor
cancerous portion of the esophagus and nearby lymphnodes
ESOPHAGOGASTRETOMY:-Itis the removal of lower esophagus and the
upper part of stomach that connects to the esophagus
71.
72. • OESOPHAGEALDILATATION:-
Therapeutic endoscopic procedure that enlarges the lumen ofthe oesophagus.
Types:-
Mercury-weighted bougies
Bougie over guidewire dilators
Pneumatic dilation or balloondilatation
COMPLICATIONS:-
-Hematemesis
-oesophageal perforation
-Mediastinitis
The modified barium swallow (videofluoroscopic swallowing evaluation) is a key element in the evaluation of most patients, providing useful information for both diagnosis and management. Nasoendoscopy accompanied by a swallowing protocol is an alternative method to reach similar endpoints.
Hypermotility may result from inhibitory nerve deficiency or an imbalance between inhibitory and contractile influences.
